Evidence-based medicine: 5 steps to navigate uncertainty

Abstract

Evidence-based medicine provides a structured and practical approach for addressing the challenges of modern medicine, which is characterized by an overload of information and the need for well-founded clinical decision-making. This method consists of five steps: formulating clear structured clinical questions, conducting efficient literature searches, critically appraising the evidence, evaluating its applicability and, finally, integrating the resulting knowledge into clinical practice. The first step involves creating structured questions that address specific clinical needs, often using the widely known PICO framework developed by the Centre for Evidence-Based Medicine in Oxford. Subsequently, to avoid information overload, it is essential to manage the abundance of data by prioritizing high-quality sources and adopting strategies that can yield quick and reliable answers. The core of evidence-based medicine lies in critical appraisal, whereby the validity, importance, and applicability of studies are assessed. This process helps avoid the mistake of accepting conclusions without questioning them. The final steps emphasize integrating evidence with clinical expertise and patient preferences, highlighting that, without proper implementation, evidence-based medicine can remain a theoretical framework without practical impact. In demanding clinical settings, evidence-based medicine aims to balance care quality, efficiency, and resource management, supporting professionals in making optimal, evidence-based decisions to improve health care.

Keywords: Critical appraisal; Evidence-based medicine; Lectura crítica; Medicina basada en la evidencia; Pediatrics; Pediatría; Pregunta clínica estructurada; Structured clinical question.